Posts Tagged ‘thyroid tests’

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His and hers low thyroid

February 27, 2010

With all that’s going on with my thyroid, I thought I’d relate this quick story about my wonderful husband. Back in December he complained to his doc of being tired, at my behest. I think he would hate for me to list out his symptoms but he has most every symptom of low thyroid except for weight gain. And his mom is hypothyroid and has been on Synthroid forever. The doctor (we have the same doctor, you may remember – she doesn’t know what a Free T3 is…) put him in for all the regular tests, including a TSH for his thyroid. January was just absolutely tragic for us and involved traveling back home for a death in our family. Between that and his job, and his migraines, he didn’t actually get the blood drawn until late January. He had a follow up with the doc recently and got the results. My husband’s TSH is 3.6.3.6! And surprise, surprise, the doctor says he’s just fine.

Are you SERIOUS? Even if you want to worship TSH, and I know first hand that his doctor does! what about the reference range? You know, the one we’re all supposed to be using that was recommended by the American Association of Clinical Endocrinologists way back in 2003? According to that reference range, 3.3 is the cut off! Well, reference range is after all, just a suggestion, and all labs use their own. Turns out our labs cut off at 4.2 – over that you’re hypo. So we are both out of luck for a diagnosis. How lucky we are. And by the way, what a coincidence that my husband and I are both just whiney, lazy, sad tired people with cold hands!

I know I complain a lot about my healthcare arrangement. I honestly don’t think there is anything especially bad about my specific healthcare facility/coverage or the specific doctors’ attitudes towards and care of myself…I never have, and this proves it because my husband is now facing the same thing. I’m mostly concerned about the state of conventional medicine overall.  And the state of our finances! We are already paying out of pocket for my holistic MD, a hormone specialist who is treating all of my hormone imbalances (update coming early next week) and it looks as if we now have to send my husband in to see the holistic as well. That’s two of us paying full price to see him, but at least we will both feel better in the end.

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My Thyroid Tests (Take I)

January 8, 2010

Wednesday I got back the results of all the tests that the regular doc put in for me based on my holistic doc’s request. I am still waiting on my saliva test results for adrenal function, done at a different lab (and on my dime) and I will have to take the hormonal tests on the 21st. There are a few tests I may have to purchase from a lab on my own, depending on the events of the next few weeks. First of all a “comprehensive thyroid panel,”  at least at my health center, is far from comprehensive, and I think this is very important to know, in addition to knowing how dangerous it can be to depend soley on the TSH for diagnosis. My holistic doctor clearly asked for a free T3 and Reverse T3 test; my regular doctor took a look at his request and said ok.  What I got was:

TSH
Thyroxine (T4)
T3 Uptake
Thyroxine, Free (FT4)
Free T4 Index
T3 (Thyronine) Total

And everything was in range by the way; the Total T3 was at the bottom of the range, just as it was a year or so ago for my last thyroid panel. I asked where the Free T3 was and the doctor pointed to the T3 Uptake. I told her that wasn’t it and she pointed to the T3 Total. So I gave up and figured I would have to find and pay for the test on my own. It is confusing but here is what Dr. Kenneth Woliner says about the difference between Total T3 and Free T3:

Triiodothyronine (T3) is a thyroid hormone that circulates in blood almost completely bound (]99.5%) to carrier proteins. The main transport protein is thyroxine-binding globulin (TBG). However, only the free (unbound) portion of triiodothyronine (free T3) is believed to be responsible for the biological action. Furthermore, the concentrations of the carrier proteins are altered in many clinical conditions, such as pregnancy.

In normal thyroid function, as the concentrations of the carrier proteins changes, the total triiodothyronine level also changes, so that the free triiodothyronine concentration remains constant. (In an abnormally functioning thyroid, this is not necessarily so). Measurements of free triiodothyronine (Free T3) concentrations, therefore, correlate more reliably with your clinical status than total triiodothyronine (T3) levels.

Alien Robot Girl of Plant Poisons and Rotten Stuff sums it up beautifully in her latest post; I would refer you there if you are by any chance going through the same thing and in need of information about which tests are relevant.

I’m being referred to an endocrynologist, although I’m a bit surprised considering my normal test results. Its possibly due to the fasting glucose test, the results of which I will discuss in a separate post. This will be my first foray into endocrynology, considering I’ve always been denied my requests to see one in the past. There is a chance that she will take the Free and Reverse T3 for me but I am going to have to purchase them from an outside lab if she will not. And I am not expecting that she will. I would be experiencing high stress and anxiety now over the thought of the experience ahead of me, but I do not need to do so, considering that I have my holistic doctor working in earnest to actually figure out what is wrong with me, rather than trying to get me out of the office quickly and with the full weight of blame on my shoulders for all my physical ailments.

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A battery of tests

January 5, 2010

So back to the story of the new doctor. After getting next to nowhere with my health center doc (or her replacement) I went ahead and found a new doctor. I looked around for an M.D. with a holistic practice, willing to prescribe natural thyroid meds (if thyroid turned out to be my problem then I didn’t want yet another fight on my hands) and a demonstrated understanding of SIBO/IBS. And since I would be paying out of pocket, the new doc also had to be in my price range.

A few emails and phone calls later I had found my guy. He didn’t diagnose me over the phone, but he said I sounded sick (obviously he was attempting to curry my favor right away! – imagine listening to me describe my symptoms and then flattering me by saying that I sound ill!) He mentioned a few things that he would look into were I to become his patient, such as low thyroid function and hormonal imbalances as well as fibromyalgia. He recommended me to look over his preferred treatment protocol and told me to call back and schedule an appointment if I liked what I saw. Which I did, so then I did.

Schlepping all the way from Queens to his Brooklyn office in the snow wasn’t easy (regardless of what you see on the map, the two boroughs are not that convenient to each other!) He asked about my symptoms and within a few sentences he was naming them all for me. Salt cravings, weight gain, inability to get warm, low blood pressure, lots of colds, PMS and painful periods. He definitely listened to me when I talked but he did tell me pretty quickly that he had my diagnosis all ready based on just a few answers – adrenal fatigue and hypothyroidism. He gave me a saliva test for cortisol to take home and perform. And a laundry list of bloodwork to get wherever I could and bring back to him for analysis to test for not only thyroid, but blood sugar problems and wacky hormone levels suggestive of Poly-cystic Ovarian Syndrome (PCOS.) He also gave me a prescription for Nystatin to clear up any yeast that I might have.

Walking to the train in the snow with my husband, I didn’t know exactly how to feel. I was exhilarated that someone with medical authority had finally declared me truly ill. I was terrified that I wouldn’t be able to get the tests done at the health center and worried that I could never pay for them on my own. I was a little skeptical and here is why. In a perfect world, where I would name off all of the things that I would suspect might be causing my symptoms, between a lifetime of a sluggish metabolism, suddenly getting ill four years ago, and then crashing into a brick wall this summer with my energy levels, weight control and digestion, he named every last one of my suspicions. Including a few things you really only hear from holistic doctors, things I used to “not believe in.” Thankfully, I’ve recently learned a lot about yeast from a really well-researched Yahoo group member; were it not for her I may have mistrusted any doctor willing to give me an antifungal. I had also just begun to research adrenal fatigue before I saw my new doctor, and between some reputable sources recently coming out about having or suspecting this condition, and every last one of the symptoms fitting me, I think I’m willing to accept it.

So back I went to the health center. Replacement Doctor had put me in for a transvaginal ultrasound to check for fibroids or ovarian cysts. And a chest x-ray for who knows what, my only guess, thanks to a helpful Yahoo group member, (do I talk about these guys a lot lately or what?) would be sarcoidosis. Both were entirely uneventful outside of having to drink about eight million gallons of water in prep for the ultrasound, which was miserable because I visibly and painfully bloat when I have to pee. Additionally, the technician was fantastic; we discussed girl diseases, gluten-free living and dismissive doctors while she probed me!

Then I saw my (old, regular) doc. I told her of her replacement’s dismissive attitude. I told her that nothing had gotten any better. I told her what had happened with the new doctor (I lied and said he was recommended to me by a friend of the family.) I made some purposely muddy statements about family medical history (being adopted, there is a lot that I do not know and in the past this has been held against me.) I sheepishly handed her the list of tests. All while the nurse was getting my BP and other vitals. Then she put me on the scale. “Wow, you have gained a lot of weight.” The words never sounded so lovely to me. She started ordering the tests. One by one, she put in almost every single lab that my new awesome holistic doctor had ordered for me.

I went in again a few days after Christmas to let them draw blood. It took two days of trying to get up early enough to go before work to actually get there. I went over all the labs with the technicians to make sure they would not do the hormone tests; as the doctor had asked me to do those on the 21st day of my cycle. Blood was drawn for a Vitamin D test, (Replacement doc denied me this test since my calcium levels months ago had been fine,) AM Cortisol, DHEA, Iron, B12 (even though I just tested terribly high two months ago) Hemoglobin A1C, and a comprehensive thyroid panel. I had terrible diarrhea after drinking the dextrose solution for the fasting insulin test. I ate lots of carbs that day thanks to getting all freaked out by 75 grams of sugar at 8 AM. I have eaten very clean ever since that day, as my bloating and abdominal aching have been quite bad due to my period. I’m going to go in on the 21st (because my cycle has it like that this month) and have more blood drawn for hormonal testing.

I will get the results of the tests tomorrow. Normally this would be a really harrowing experience and I would be getting a little anxious about going to the center just to get handed a bunch of normal results and told that I really just need to relax and exercise. Instead, I am just not that tense about it now, knowing that whatever the tests say, I will just smile and nod and take the labs to the new doc at the end of the month and let him make the decisions. I am  probably most interested in the results of the ultrasound,  since I had one a while back and never got the results but yet many a gynecologist (I have gone through a few but not by choice) has told me that my lady parts are riddled with cysts and fibroids. And I am a little worried that the health center’s idea of “comprehensive” just isn’t. I was put in for a thyroid panel back in 2007 and it didn’t include the very important free T3 test that my new doc wants. However, these things must be dealt with as we get to them; no more stressing out over future worries. Just a few weeks ago I thought I was staring at thousands of dollars worth of labs and I didn’t think I’d get any cooperation from my health center. Now they’ve done the lion’s share of them already. And I just found out that a program through my job will reimburse part of any of my out-of-pocket medical costs for tests. So anything can happen, and worrying about the future won’t get us anywhere. Bleeding a lot, into several small tubes, however, will.

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A new doctor

December 29, 2009

I mentioned a few posts back that I was going to see a new doctor, but I didn’t elaborate on the events that led up to that decision. If you’ve been reading since the summer you’ll know that I’ve not just been dealing with what are typical SIBO symtpoms for me lately, bloating, diarrhea and body aches; in fact, although I have been dealing with these symptoms, I would say that they have not been at their worst lately. Rather what I have been experiencing is crushing fatigue, crazy nightmare monthly periods, a heightened frequency of syncope, muscle weakness, and between August and October I packed on 20 lbs (14 of those by the end of September) and this weight isn’t going anywhere.

In October I had gone to see my regular doc at the health center, to see if she had any suggestions on the fatigue. It is important to note that I recently requested my entire medical record from the center and one of the many things I was surprised to see is that there is no mention of SIBO in there at all, outside of doctors writing things like “Patient says she has “S.I.B.O”” or “She says she has bacterial infections in her digestive tract…” This is because the health center never has offered the breath test for SIBO, so I had to go outside the facilities to find a doctor in NYC who did. Even my gastro who offers me Xifaxan mentions the SIBO by proxy in his files on me, since he isn’t the one who diagnosed me with it. So really I was starting kind of fresh with this doctor’s visit, and that was fine by me. Turns out I had an even fresher start than I imagined, as my own doc was out sick that day and I saw someone entirely new. I told her I was fatigued and that I had gained weight. She put in a few tests for me – a Comprehensive Blood Panel (CBC) and a TSH test (one of the thyroid? hormones.) I also had a standing order for a B12 test from my gastroenterologist.

Of course everything came back within range. Some noteworthy figures – my cholesterol has gone down again and now sits at 169. My HDL has increased from 75 to 85. My blood pressure that day was 98/64. And I had a TSH of 1.9.

I am no thyroid expert, so I’ve been doing quite a lot of research lately and from what I can tell this is a great number. In fact, even in the world of lower ranges, healthy people, and thyroid patients doing well on the right medication, 1.9 seems to be a number where many people feel great, although some need to be as low as 1 to feel good. Historically, however, it is somewhat high for me. Back in July of 2007, at a weight of 177, before I started eating meat and exercising and dieting, my TSH was 2.06. A year later I was 20 lbs lighter and it was down to 1.72. This June, at my lightest (and most energetic) it was down to 1.32. Now 6 months later its at 1.9. Its funny having to get into a brand new field of research; I really don’t know if this type of fluctuation is considered negligible or if it is actually important. All I do know is that I felt very differently at each of these times.

And of course I am completely aware of the TSH is worthless theory, and I don’t say I knock it, but I always try and give conventional medicine the benefit of the doubt to start with anyway. More on this later.

So all the test results were good, everything was within range and only one indicator – the G-GTP, or Gamma-Glutamyltranserase, was at the bottom of the normal range (normal being 7 – 51, my result was 8.) I believe that G-GTP is a bilary enzyme. My B12 blood levels were actually high: 996, where my lab’s top number is 948. So the doctor gave me a clean bill of health and then stared at me blankly. Of course I was upset. Why in the world am I feeling so fatigued? She told me I was probably getting too much sleep and to get out of bed earlier. I asked her about the weight gain and she said nothing at all and kept writing in her book. I asked what I should do about the painful periods and she scheduled me for a transvaginal ultrasound and a chest x-ray.  

So much for a fresh start. We called the new doc, scheduled an appointment and started saving up for his consultation fee. And I’ll discuss his initial findings and the tests he ordered for me in the next post.